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INTRACRANIAL PRESSURE
Dr.Muhammad Yusuf,SpS FINS
INCREASED ICP
Outline
Bony structure
Brain & interstitial fluid 80%
Blood (CBV) 10%
CSF 10%
Monroe- Kellie Doctrine
Brain
Blood
CSF
Cerebral Blood Flow
Cerebral Edema
increase in brain volume
increase in Na+ and H2O
Classification of Cerebral Edema
Interstitial
Vasogenic
Cytotoxic
Interstitial Edema
Prototype
- obstructive hydrocephalus
Vasogenic Edema
HIE
Re-perfusion injury
Osmotic disequilibrium
Symptoms of Increased ICP
Headache
Bulging fontanels
Papilledema
Altered mental status
Neurological deficit
- common is 3rd nerve palsy
- dilated pupil(s)
Increased ICP
Try to prevent
Primary injury
-parenchymal damage
Secondary injury
- reaction of neural tissue to injury
edema
cell death
Factors That Worsen Secondary
Injury
↓ BP
↓ PaO2
↑ PaCO2
INCREASED ICP
Monitoring
Non-Invasive Invasive
Assess perfusion Intubation
A-line
BP measurement CVP
Jugular venous bulb
Prevents ↑ BP ↑ ICP
Prevents agitation
INCREASED ICP
Glucocorticoids
Useful in peritumoral and intratumoral
edema
Improves tumor glucose utilization, decreasing
necrosis and edema formation.
Phospholipase A2 activity is blocked , less
arachidonic acid is formed and PG, TXns, and LTs
thus less endothelial permeability.
Inhibits inflammatory cell lysozyme thus decreasing
inflammatory cells.
Indications for ICP monitoring
GCS ≤ 8
Epidural
Purpose of ICP Monitoring
Prevention of Herniation…
What to do with the information?
Goal: Adequate oxygen delivery to
maintain the metabolic needs of the
brain.
Mannitol
- dehydrates the brain, not the patient
- monitor osmolality
Hypertonic saline
Manipulation of ICP
Blood
External drainage
- therapeutic as well as diagnostic
- technical issues
- infectious issues
Manipulation of CPP
CPP = MAP- ICP
Central Herniation
- downward displacement of the hemispheres
and basal nuclei inferior displacement of midbrain
& surroundings thru tentorial notch
Bradycardia
Hypertension
Altered respiratory status